This text provides the in-depth understanding of the mechanisms that guide coding and reimbursement. The text is meant to be useful to surgeons in practice, both in general surgery and in surgical subspecialties; practice management teams of surgical practices and to resident physicians in surgery. Part 1 of the text addresses the CPT coding process, the relative valuation system (RVU), the ICD-9 and ICD-10 systems of classification, Medicare Part B payment rules for physicians, the DRG system and Medicare Part A payment for hospitals, alternative payment models, and the myriad of quality measures of importance to surgeons. Part 2 of the text addresses specific coding in areas where surgeons historically have had the most difficulty. This is not meant to substitute for the available texts, software or courses on coding, but to provide the historical background and rationale for the specific coding rules. Principles of Coding and Reimbursement for Surgeons will be of great value to general surgeons and surgical subspecialists in private practice, academic institutions, and employed positions. It will provide direction to management teams from practice and institutional levels. It is also of use to surgical trainees and to researchers in health policy issues.

The Essential Guide to Coding in Otolaryngology: Coding, Billing, and Practice Management, Second Edition is a comprehensive manual on how to properly and compliantly code for both surgical and non-surgical services. It is a practical guide for all otolaryngology providers in the United States, including physicians early in their career requiring a working knowledge of the basics, experienced providers looking to understand the latest updates with ICD-10-CM and CPT changes, related specialists (audiology, speech pathology, and physician extenders) providing otolaryngologic health care, and office administrative teams managing coding and billing. Included are sections on how to approach otolaryngology coding for all subspecialties in both the office and operating room. Foundational topics, such as understanding the CPT and ICD-10-CM systems, use of modifiers, managing claim submissions and appeals, legal implications for the provider, coding for physician extenders, and strategies to optimize billing, are presented by experts in the field. Focused on a practical approach to coding, billing, and practice management, this text is user-friendly and written for the practicing physician, audiologist, speech pathologist, physician extender, and coder. The income and integrity of a medical practice is tied to the effectiveness of coding and billing management. As profit margins are squeezed, the ability to optimize revenue by compliant coding is of the upmost importance. The Essential Guide to Coding in Otolaryngology: Coding, Billing, and Practice Management, Second Edition is vital not only for new physicians but for experienced otolaryngologists. New to the Second Edition: * Strategies for integrating revised guidelines for coding and documenting office visits * New and evolving office and surgical procedures, including Eustachian tube dilation and lateral nasal wall implants * Updated coding for endoscopic sinus surgery and sinus dilation * Billing for telehealth visits * Revision of all sub-specialty topics reflecting changes in coding and new technologies * New and revised audiologic diagnostic testing codes Key Features * All chapters written by practicing otolaryngologists, health care providers, practice managers, legal experts, and coding experts * Discussion of the foundations of coding, billing, and practice management as well as advanced and complex topics * Otolaryngology subspecialty-focused discussion of office-based and surgical coding * Tips on how to code correctly in controversial areas, including the use of unlisted codes * A robust index for easy reference

The newest edition of this best-selling educational resource contains the essential information needed to understand all sections of the CPT codebook but now boasts inclusion of multiple new chapters and a significant redesign. The ninth edition of Principles of CPT(R) Coding is now arranged into two parts: - CPT and HCPCS coding - An overview of documentation, insurance, and reimbursement principles Part 1 provides a comprehensive and in-depth guide for proper application of service and procedure codes and modifiers for which this book is known and trusted. A staple of each edition of this book, these revised chapters detail the latest updates and nuances particular to individual code sections and proper code selection. Part 2 consists of new chapters that explain the connection between and application of accurate coding, NCCI edits, and HIPAA regulations to documentation, payment, insurance, and fraud and abuse avoidance. The new full-color design offers readers of the illustrated ninth edition a more engaging and far better educational experience. Features and Benefits - New content! New chapters covering documentation, NCCI edits, HIPAA, payment, insurance, and fraud and abuse principles build the reader's awareness of these inter-related and interconnected concepts with coding. - New learning and design features -- Vocabulary terms highlighted within the text and defined within the margins that conveniently aid readers in strengthening their understanding of medical terminology -- "Advice/Alert Notes" that highlight important information, exceptions, salient advice, cautionary advice regarding CMS, NCCI edits, and/or payer practices -- Call outs to "Clinical Examples" that are reminiscent of what is found in the AMA publications CPT(R) Assistant, CPT(R) Changes, and CPT(R) Case Studies -- "Case Examples" peppered throughout the chapters that can lead to valuable class discussions and help build understanding of critical concepts -- Code call outs within the margins that detail a code description -- Full-color photos and illustrations that orient readers to the concepts being discussed -- Single-column layout for ease of reading and note-taking within the margins -- Exercises that are Internet-based or linked to use of the AMA CPT(R) QuickRef app that encourage active participation and develop coding skills -- Hands-on coding exercises that are based on real-life case studies

An invaluable resource for surgeons, surgical leaders, and health system administrators at all levels, Healthcare Delivery in Surgery: Scientific Principles and Practice provides unique, expert coverage of common challenges in the delivery of surgical care. Editor Justin B. Dimick, MD, MPH, Chair of the University of Michigan’s Department of Surgery, leads an outstanding editorial team from the UM Center for Healthcare Outcomes and Policy who provide clear guidance on the strategy and operations of delivering optimal surgical care. Using a case-based approach, authors consider the underlying principles and existing evidence followed by real-world practical solutions.

This book presents different patient-oriented perspectives from surgeons, economic evaluation and management researchers, and business companies active in the healthcare sector, striking a balance between the appropriateness/effectiveness of treatment and efficiency/cost. It does not include technical surgical details, but instead provides the necessary knowledge regarding different groups of patients to help economic and management researchers make accurate evaluations. Although partially based on the specific case of abdominal wall surgery in the Italian health system, the book defines a model that can, with the necessary adaptations, be applied in other national contexts. It also analyzes different reimbursement systems and methods of data collection. This approach supports the evolution from evidence-based medicine (EBM) to the future of real-world data (big data analysis). Further, it highlights the critical issue of “silos” reimbursement, which is the pillar of DRG, and proposes methodology to evaluate the direct and indirect benefit and costs of surgery (for example quality of care, costs incurred in cases of surgical complications due to the use of inappropriate, low-cost material or due to surgical procedure. It is a valuable resource for clinicians, surgeons, policymakers and managers in the field.

Provides a diverse, multi-faceted approach to health care evaluation and management The U.S. Health Care System: Origins, Organization and Opportunities provides a comprehensive introduction and resource for understanding healthcare management in the United States. It brings together the many "moving parts" of this large and varied system to provide both a bird's-eye view as well as relevant details of the complex mechanisms at work. By focusing on stakeholders and their interests, this book analyzes the value propositions of the buyers and sellers of healthcare products and services along with the interests of patients. The book begins with a presentation of frameworks for understanding the structure of the healthcare system and its dynamic stakeholder inter-relationships. The chapters that follow each begin with their social and historical origins, so the reader can fully appreciate how that area evolved. The next sections on each topic describe the current environment and opportunities for improvement. Throughout, the learning objectives focus on three areas: frameworks for understanding issues, essential factual knowledge, and resources to keep the reader keep up to date. Healthcare is a rapidly evolving field, due to the regulatory and business environments as well as the advance of science. To keep the content current, online updates are provided at: healthcareinsights.md. This website also offers a weekday blog of important/interesting news and teaching notes/class discussion suggestions for instructors who use the book as a text. The U.S. Health Care System: Origins, Organization and Opportunities is an ideal textbook for healthcare courses in MBA, MPH, MHA, and public policy/administration programs. In piloting the content, over the past several years the author has successfully used drafts of chapters in his Healthcare Systems course for MBA and MPH students at Northwestern University. The book is also useful for novice or seasoned suppliers, payers and providers who work across the healthcare field and want a wider or deeper understanding of the entire system.

This two volume set LNCS 10438 and LNCS 10439 constitutes the refereed proceedings of the 28th International Conference on Database and Expert Systems Applications, DEXA 2017, held in Lyon, France, August 2017. The 37 revised full papers presented together with 40 short papers were carefully reviewed and selected from 166 submissions. The papers discuss a range of topics including: Semantic Web and Semantics; Graph Matching; Data Modeling, Data Abstraction, and Uncertainty; Preferences and Query Optimization; Data Integration and RDF Matching; Security and Privacy; Web Search; Data Clustering; Top-K and Skyline Queries; Data Mining and Big Data; Service Computing; Continuous and Temporal Data, and Continuous Query Language; Text Processing and Semantic Search; Indexing and Concurrency Control Methods; Data Warehouse and Data Stream Warehouse; Data Mining and Machine Learning; Recommender Systems and Query Recommendation; Graph Algorithms; Semantic Clustering and Data Classific ation.

Resource ordered for the Health Information Technology program 105301.

This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.